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Nursing home neglect

A private nursing home chain enforced such strict rations on diapers that staff wrapped residents in towels and plastic garbage bags to keep their beds dry.

Lorraine Henderson holds photograph of her father, Donald, who died after developing an abscess on his rectum. An inspection found staff at his nursing home repeatedly performed improper enemas. (JESSE MCLEAN / TORONTO STAR) | Order this photo

Donald Henderson was a resident at Victoria Village in Barrie. He died from an infection after an improperly performed enema.

Donald Henderson and son, xxx. Henderson, a WWII vet died of infection after an improperly performed enema at his nursing home.

Donald Henderson as a younger man. He fought in Italy and other countries during WWII.

A private nursing home chain enforced such strict rations on diapers that staff wrapped residents in towels and plastic garbage bags to keep their beds dry.

A resident at a Bradford home who was prone to falls was left alone on a toilet. The resident fell and sustained a head injury.

Residents in a Hamilton home had untreated bedsores and were famished from lack of food.

An elderly woman with a broken thighbone in a Pickering nursing home suffered for days without treatment.

A Brantford home was so short staffed that residents frequently missed their weekly baths.

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Eight years after an Ontario government promise to revolutionize nursing home care, the elderly are still suffering neglect and abuse.

Responding to Thursday’s front page Toronto Star story on the rape of one senior in a home, allegedly by a male nurse, Health minister Deb Matthews has called an emergency meeting at her office with nursing home leaders Friday to find out what is going wrong in the publicly funded system.

“I need to have a very, very serious conversation with them,” Matthews said.

“(Homes) have a duty to report (assaults and abuse.) I need to know they are following the law. We have zero tolerance for homes that break the rules.”

The Star’s investigation draws from material uncovered by a new inspection system created by the Ministry of Health and Long-Term Care in July 2010. It has since investigated 2,993 complaints and critical incidents, like broken bones or assaults.

We analyzed more than 1,500 of those inspection reports and found at least 350 cases of neglect where residents were left in soaking diapers, suffered untreated injuries, bedsores, dehydration, weight loss or were put at risk from outdated care plans that ignored changing medical needs. Other reports, scrutinized for Thursday’s story, focused on abuse.

Today the Star probes the issue of neglectful treatment of home residents.

The reports reveal that many families have no idea what their loved ones are subjected to. Inspectors found that some homes do not disclose problems to the ministry or police.

For example, Hallowell House in Picton, owned by the private chain Revera Long Term Care, did not immediately notify families of four residents to say their loved ones had suffered “neglect related to their continence care,” according to a ministry report from a September 2010 inspection.

The neglect stemmed from a staff member who skipped a room during rounds, Janet Ko, Revera’s vice president of communications, said in an email.

Ko said staff on the next shift, which began two hours later, tended to the residents. The home has since reviewed its procedures on notifying family, she said.

Diaper shortages can be found in many of Ontario’s 627 homes, said Sharleen Stewart president of the union representing front-line nursing home staff.

“Our members tell us the shortages leave residents with rashes and sores,” said Stewart, of the Service Employees International Union, which represents 50,000 Ontario health care workers, including 22,000 nursing home employees.

The health ministry gives homes a maximum of $1.20 a day to buy diapers for each resident.

At Revera, the company told the Star it “spends every penny it receives for continence care on continence care.”

There were similar problems at three other Revera homes. Ministry investigators found that staff members had complained of diaper shortages.

In her statement, Revera’s Ko wrote, “This is a complex area and there isn’t a one-size fits all approach to managing cases. Each resident requires an individualized plan that looks at their unique needs and requirements.

“We take these matters very seriously, and for us one incident is one too many.”

Last November a ministry inspector wrote, “Five different nursing staff members working the day shift from all home areas… indicated they are only provided with one (diaper) per (eight hour) shift for the resident and frequently have to go to another home area to try and borrow products.”

The report also described a resident with an open sore whose diaper was soaked in the morning. Since staff could not find a replacement, the resident was only given a paper insert to keep urine from the senior’s wound.

Two months later, in January 2011, the ministry was back at the same home, this time investigating a complaint from a family who said their loved one was wearing the same diaper from the previous day and it was “heavily soiled.”

The inspector found the home broke the provincial regulation that requires residents have enough diaper changes to remain “clean, dry and comfortable.”

Revera’s Ko called Garden City Manor’s problems “very unfortunate” and said the company has done a number of things to fix the problems, including “a change in clinical leadership at the site.” Staff were also given new training.

Ko dismissed allegations that a Revera home in north Etobicoke rations diapers.

But one current and one former resident of Westside Long Term Care on Albion Rd. told the Star residents are only given one diaper per eight-hour shift.

“That’s all we ever get — one a shift,” said 88-year-old resident Doreen De Guara.

“They shouldn’t have to go looking for briefs when they’re needed,” De Guara said. “It’s not right.”

She praised the staff, saying they scramble to find an extra diaper if one’s needed.

“They’re embarrassed that I’m embarrassed.”

Evelyn Evans lived at Westside for 18 months until early October when she moved to a new facility in Brampton.

At Westside, Evans said she kept a private supply of pull-ups in her room, which were more comfortable than the cheaper diapers the home purchased.

It took staff longer to get residents into pull ups, she added, so the home used diapers that were fastened at the sides with tape.

“Sometimes that tape would break apart and the resident got soaked that way,” she said. “Or, half an hour into a diaper change they'd have an accident and they had to sit in it until it was time for their next change.”

At Evans’ new home, staff told her she can have as many briefs as needed.

“I love it here,” she said.

Two employees at Westside said the home locks up diapers and staff have to sign them out.

The workers at Westside spoke on the condition of anonymity, saying they are afraid of being fired.

One worker said she is so worried about leaving residents in wet diapers that she places towels and plastic garbage bags under them to prevent urine from soaking their bed sheets.

“Management says they are on a budget and have to cut back. So, we try to do whatever we can to keep them comfortable,” the worker said.

Ko said Revera was “shocked” to hear allegations that makeshift diapers were being used and she has both launched an investigation and is conducting educational sessions for staff. The company, she said, has reported the issue to the ministry as a case of “suspected harm.”

At Westside, Ko said, a “supply of continence care products are on hand and back up supplies are available.”

Westside workers say their bosses warn staff they will be fired if they tell residents’ families the home is rationing diapers.

Whistleblower protection in Ontario homes only helps staff who divulge problems to their nursing home supervisors or the health ministry.

It does not protect the jobs of workers who warn residents’ families that their relatives are being neglected, complain to their union or speak to the media.

Front-line workers union official Stewart said she regularly hears these concerns.

“A lot of problems are being covered up, they’re not going to report on the negative in their own homes,” she said.

The ministry’s inspections rely on the homes to report their ‘critical incidents’ or families to register complaints. Many inspections have succeeded in rooting out problems inside the homes.

At Brantford’s Leisureworld Caregiving Centre, staff shortages meant residents were frequently not being bathed. The bath nurse would be reassigned to cover other duties and residents would be left for days without being cleaned.

“There was a gap (in care) occurring,” said Linda Prince, the home’s director of administration. “Resident care is our highest priority. When issues are identified, we immediately take action.”

The home introduced a new care system in which staff members are responsible for certain residents and all their needs, including baths. The residents and the staff are pleased with the new system, Prince said.

At Bradford Valley, north of Newmarket, a resident deemed to be at “high risk” of falling was left alone on the toilet. The resident tumbled and sustained a head injury.

The home’s staff has since received additional training on toileting procedures and fall prevention, said administrator Luanne Campeau.

“This was an extremely unfortunate and unusual incident,” she said. “I need to say that this does not represent the care provided at Bradford Valley.”

Grace Villa Long Term Care Home in Hamilton, where inspectors found residents with untreated wounds and seniors left hungry, didn’t respond to numerous requests for comment.

The new inspection report system often hides bad care from public scrutiny.

The public report is often stripped of details. A private version for the home’s management, on the other hand, gives precise information about each violation.

It took Lorraine Henderson 11 months to obtain copies of these private reports through access to information legislation.

She had complained that her father’s rectum was ripped after a registered practical nurse at Victoria Village Manor in Barrie improperly gave him an enema.

A ministry inspector found that the invasive procedure was done incorrectly three times and later, when the 87-year-old World War Two vet was in obvious pain, staff did little to relieve his suffering. Donald died on September 12, 2010.

During Donald’s final days, Henderson said she and her family approached the home’s director of care four times with concerns about the facility’s investigation into the improper enema.

The information couldn’t be released for privacy reasons, Henderson said she was told.

The inspection reports she later received revealed that the home broke several rules, including failing to respond to Henderson’s complaint.

“I still haven’t heard from anyone at the home,” Henderson said. “There has always been an air of secrecy around this whole thing.”

In written statements to the Star, the home’s administrator said neither the ministry’s inspection nor a coroner’s post-mortem connected Donald’s death to the treatment he received.

“We are saddened by Don’s passing and we feel for the Henderson family in their loss,” Olivia Schmitz said.

“Victoria Village Manor has willingly complied with all the investigations into Don's care and we can confirm that the care he received was thorough, proper and appropriate, and had no correlation with his decline and passing.”

Schmitz did not answer questions concerning the improper enemas.

The Star’s analysis of inspection reports found more than 50 cases in which elderly residents fell and got injured, many times when they were left unassisted by caregivers or dropped from mechanical lifts.

The lifts require two staff members to operate, but caregivers repeatedly tried to do it on their own. In other cases, the sling holding the resident hadn’t been hooked to lift properly.

In a number of cases, the injured resident waits several days for proper treatment.

Margaret Miller was a 91-year-old resident with dementia living in Community Nursing Home Picking nursing home when her thighbone was somehow broken. It went untreated for three or more days.

Nursing home records from March 20 said Miller’s right thigh appeared “significantly more swollen” than the left. She had vomited twice during the day.

Two days earlier, Miller’s daughter, Janet, visited her mother.

In an interview, Janet said she noticed her mother’s leg was severely bruised and her hand was curled up in a claw-like grip. At the time, she thought her mother might have had a stroke, but said a nurse assured her that nothing was wrong.

On March 23, Miller was taken to the hospital. Janet recalled a hospital emergency department nurse telephoned her and said ‘get over here right away.’

“When I got to the hospital the nurse told me my mother’s femur was broken,” Miller said. “She looked at me and said, ‘The femur is the strongest bone in the body.’

“Before I left the hospital, the nurse literally grabbed me by the hand and took me to the x-ray room. The x-ray showed that my mother’s bone was completely broken, sticking up at a 45-degree angle.”

The bruising on her mother’s leg had turned green. “That means the injury was not fresh,” she said.

Janet said she didn’t call the home to complain. Nor did she call the ministry. She called the police.

“I didn’t see much concern from the home, so I decided to call an outside source,” she said.

Miller died less than two weeks later.

Last May, police charged a personal support worker at the home with criminal negligence causing death. The crown attorney dropped the charges two months later because it determined there was no reasonable prospect of conviction.

Metzie Lacroxi, administrator of Community Nursing Home Pickering, said she could not comment on the details of the case because it is still the focus of a coroner's investigation.

Lacroxi said the home does not have an x-ray technician in the building so it often takes two or three days to get residents checked for broken bones.

Since Miller's death, the home has re-trained its workers on the proper use of mechanical lifts, which help the elderly in and out of bed, Lacroxi said.

One month before Miller’s leg was broken, Ontario health minister Deb Matthews visited the woman’s unit at the home.

Matthews was there to congratulate the staff on its falls prevention pilot project, which had cut accidents in the unit by 50 per cent.

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